The Prevention of Musculoskeletal Disorders within the Telecommunications Sector What the Science Te

1
The Prevention of Musculoskeletal Disorders
within the Telecommunications Sector -What the
Science Tells Us
Dr Joanne Crawford Miss Elpiniki Laiou Dr Grant
McMillan Dr Anne Spurgeon
The Institute of Occupational and Environmental
Medicine
2

• Outline of Presentation
• Methodology
• Results
• Identification of best practice in manual
  handling and DSE use in the telecommunications
  industry
• Data Gaps

3
Methodology
The review followed the systematic methodology
developed by the Centre for Reviews and
Dissemination at the University of
York. Keywords derived after scoping work and
discussion with sponsor Searches were carried
out electronic databases including Medline,
Ergonomics Online, Psychinfo
4
Methodology
Inclusion criteria were developed for the first
screening of abstracts/summaries of each article.
Each abstract was reviewed independently by two
researchers to ensure it fitted the following
criteria Population telecommunication workers
including service technicians and call centre
workers Interventions Measurement of incidence
or prevalence of MSDs, activities including
psychosocial factors linked with the development
of MSDs, predictive factors, preventive measures
and identification of best practice
5
Methodology
Inclusion criteria continued Outcome all
outcomes were assessed in relation to the
studies obtained based on the population,
interventions and study design. Study Design
Randomised Controlled Trials (RCTs), Quasi-experim
ental, Cross-sectional, Case Reports, Observationa
l and Qualitative Research
6
Methodology
Review Strategy 184 papers were obtained for the
review and two team members reviewed each paper
independently. Papers were assessed on the
following criteria- Strong evidence
provided by consistent findings in multiple
high quality studies Moderate evidence,
provided by generally consistent findings in
fewer or lower quality studies Limited or
contradictory evidence produced by one study or
inconsistent findings in multiple studies - No
scientific evidence
7
Which MSDs are likely to be associated with
telecommunication working and specifically
underground cabling work and portable DSE use in
vehicles?
Service Technician Work Back injuries associated
with manhole cover removal, ladder handling,
overhead line work and cable handling. Prevalenc
e rates of Hand-Arm Vibration Syndrome were
found to range between 10-24 in utility workers
involved in road breaking work. Other symptoms
associated with service technician work include
knee, shoulder, hip/thigh and ankle/feet
discomfort in overhead line workers. in mine
workers
8
Which MSDs are likely to be associated with
telecommunication working and specifically
underground cabling work and portable DSE use in
vehicles?
Service Technicians There is a perception that
using connector tools increases the risk of
cumulative trauma disorders. No papers were found
that researched hand rodding or portable DSE use.
9
Which MSDs are likely to be associated with
telecommunication working and specifically
underground cabling work and portable DSE use in
vehicles?
Call Centre Workers A higher proportion of call
centre workers reported MSDs than other computer
professionals. The incidence of new symptom
cases for MSDs was calculated at 1.7
case/person-year for males and 0.93
case/person-year for females.   From
questionnaire studies the prevalence of MSD
symptoms ranged from 17 to 75.   Prevalence of
MSD symptoms from clinical examination was 22
().
10
Call Centre Workers The most common symptoms
reported were myofascial pain syndrome tendon
related symptoms joint related symptoms nerve
related symptoms The most common body areas
affected by discomfort were the
neck shoulder hand and wrist
11
Which functional activities in this type of work
are particular risk factors for the development
of MSD?
Manhole Cover Handling
Photo courtesy of Prevent
12
Manhole Cover HandlingThere is evidence that
manhole cover removal results in high
compression forces of the low back that are
linked to an increased risk of injury.  A
number of tools which reduce the compression
forces on the low back have also been identified.
13
Ladder handling
14
Ladder Handling
There is evidence that the handling of ladders
between 24kg and 31 kg represent a risk of
injury to those involved in carrying
them. Specific risks include - the environment
in which the ladder is used loading the ladder
onto the shoulder loading and unloading ladders
from vehicles
15
Working Overhead
Photo courtesy of Prevent
16
Working Overhead Functional activities
identified as creating a possible risk of injury
for MSDs lifting tools via a pulley
rope hammering nails into poles lifting wooden
blocks handling heavy tools crimping tool work
17
Cable Handling Cable handling in mining has been
found to have an increased risk of back injuries
associated with it.
Telephone linesmen have reported using
connecting tools as a perceived cause of
cumulative trauma disorder.
18
Hand-arm Vibration from Tools Although road
breaking techniques have changed, with enough
exposure there is a risk of Hand-Arm
Vibration from vibrating tools  
Photo courtesy of Prevent
19
Which functional activities in this type of work
are particular risk factors for the development
of MSD?
Call Centre Workers
20
Call Centre Workers The incidence of
musculoskeletal symptoms reduces with the
introduction rest breaks   Physical influencing
factors on discomfort include keyboard
height screen height above or below eye level low
level of satisfaction with the workstation non-opt
imal desk height chair discomfort shoulder
abduction and shoulder elevation  
21
Work factors positively influencing discomfort
included working with computers for the whole
working day hand/wrist symptoms were associated
with using the telephone more than 8 hours per
day
22
How important are psychosocial factors in the
development of MSD and can they be quantified?
23

Both physical and psychosocial risk factors are
implicated in the aetiology of MSDs. Psychosocial
work factors appear to have more importance for
the neck/shoulder region than the hand/wrist
region. Musculoskeletal discomfort is
significantly linked to gender age promotion/powe
r long hours negatively associated with job
satisfaction.   Back symptoms are negatively
associated with perceived degree of job control.
 
24
Arm or hand symptoms are significantly associated
with job stress increased crowding increased job
demands increased occupational psychosocial
strain decreased social support high information
processing demands Neck symptoms are
significantly associated with Job security
issues routine work lacking in decision-making
opportunities high information processing
demands not having productivity standards jobs
requiring a too large a variety of tasks    
25
Elbow symptoms are significantly associated with
Job security issues Surges in workload
Increasing time pressure Shoulder symptoms are
associated with job security issues.   It is not
possible at the current time to quantify the
impact of psychosocial factors on the development
of MSDs due to the experimental design of the
studies included in the review.
26
What predictive factors are there for the
development of MSDs in this type of work?
For Service Technician work, no papers were
identified for inclusion in the review.
27
Call Centre Workers In comparison with other
computer users, the odds ratio for being
classified as a symptom case among call centre
employees was 2.3, 95 CI1.2-4.3.   No
associations were found between symptoms and
electronic performance monitoring or keystrokes
per day in one study.   Neck symptoms were
associated with arm abduction screen position
above or below eye height shoulder
elevation bifocal use fear of being replaced by a
computer workload variability (loading) routine
work lacking decision-making high information
demands.  
28
Call Centre Workers (Continued) Shoulder
symptoms were associated with screen position
above eye height shoulder elevation job security
issues   Hand/wrist symptoms were associated with
shoulder elevation high information processing
demands.   Upper back symptoms were associated
with shoulder elevation.   Elbow symptoms were
associated with routine work lacking
decision-making surges in workload.   General
MSD symptoms were associated with time pressure
at work and work rest scheduling.
29
What measures are effective in the prevention of
MSD in this type of work?
Service Technicians No papers were identified
that evaluated the effectiveness of measures in
the prevention of MSDs in service technicians in
the telecommunications industry.
30
What measures are effective in the prevention of
MSD in this type of work?
Call Centre Workers   There is no current
evidence to support the use of forearm support
on the workstation among call centre
workers.   Interventions including occupational
health based training and muscle-learning
therapy did not reduce symptom reporting in call
centre staff. Apart from the above, no further
studies identified
31
Is health surveillance of benefit in preventing
or modifying the progression of MSDs?
When using self-report measures, the magnitude of
MSDs is greater than that identified through
medical records or medical examination.   There
is no current evidence available to support or
refute that health surveillance is of benefit in
preventing or modifying the progression of MSDs
in telecommunications workers.
32
Identification of best practice in manual
handling and DSE activities.
General Guidance on Manual Handling Primary
recommendations include- redesigning the work
reducing physical demands allowing enough space
for body movement ensuring that rest
opportunities are designed into the work Using
mechanical lifting devices rather than
bodily force.
33
Principles of Manual Handling Think before you
lift Keep the load close to your waist Adopt a
stable position Ensure a good hold on the load At
the lift start, slight bending of the back hips
and knees is preferable to stooping or
squatting Do not flex your spine any further when
you lift Avoid twisting the trunk or leaning
sideways Keep your head up when handling Move
smoothly Do not lift more than you can manage Put
down then adjust the load (Graveling, Melrose
and Hanson, 2003)
34
Manual Handling in the Telecommunications
Industry Ladder Handling Use of lightweight
materials for ladder construction. The lightest
and shortest ladder should be selected for
particular tasks. Shoulder carrying should only
be done in ideal conditions. Heavy ladders should
be carried suspended to the shoulder. Workers
should receive adequate training on ladder
handling. Ladder handlers should be trained to
risk assess the route. Ladder handling equipment
including vehicle support should be designed to
allow safer handling.
35
Manhole Cover Manoeuvre   Exploring the use of
composite materials rather than steel to reduce
the weight of the manhole covers. Ensuring that
the tools and lifting aids used to move manhole
covers reduce the biomechanical stress on the
lower back. Ensuring employees are trained in
the use of tools and lifting aids. (The authors
appreciate that in some environments, lifting aid
use is not possible.)
36
Cable Handling (external environment) The
research identified for cable handling was based
in the mining industry. Recommendations from
the research include mechanising the process
using conveyers for the cables or identifying
other means of powering the process rather than
using manual force.
37
Cable Handling (internal environment) Altering
frame heights to decrease handling zone
difficulties. Use a crimping tool with a
double-handed grip. Positioning frames to ensure
good working posture. Using trolleys to transport
equipment and cabling. Use task
lighting. Complete the work cycle (strip, crimp
terminate). Work on a supported surface for
precision tasks. Use padded mats when kneeling.
38
Exposure to Vibrating Tools Increase awareness
of vibration of a hazard. Ensure all levels of
vibration from tools are measured. Reduce
personal exposure as far as reasonably
practicable. Ensure new tools have low vibration
emissions. Establish ongoing health surveillance
for new and continuing workers. Report all cases
identified through health surveillance. Review
the requirement to dig.
39
Display Screen Equipment General Guidance
Ensuring frequent short rest breaks during the
working day. Provision of training to minimise
the risks of musculoskeletal problems. Ensuring
the minimum requirements for the workstation are
achieved. Encouraging early symptom
reporting. Ensuring workers can be rehabilitated
back into work.
40
Display Screen Equipment use in Call Centre
Workers Rest Breaks ensuring they are
timetabled and are taken Workstation Design and
Set-up a need for risk assessment of computer
workstations and ensuring staff are equipped to
set up and use workstations Work Organisation
a need to manage the issues of high demands,
routine work, surges in workload and
manage future change Psychosocial Issues a
need to identify interventions for job stress,
lack of social support, job satisfaction and
perceived job control.
41
The Use of DSE in Vehicles Advice (no research
found) is not to use portable equipment in
vehicles unless a specific workstation has been
set up.
DSE Workstation in Vehicle. Picture courtesy of
Prevent
42
4. Data Gaps
Lack of information on incidence and prevalence
of MSDs Very little high quality research in
this area No research found on hand-rodding or
DSE use in vehicles No information on the impact
of psychosocial factors on MSDs in heavy
work Lack of consistency on case definitions and
measurement tools used to identify MSDs, symptoms
or discomfort